Deep Learning: a Promising Method for Histological Class Prediction of Breast Tumors in Mammography.

The objective of the study was to determine if the pathology depicted on a mammogram is either benign or malignant (ductal or non-ductal carcinoma) using deep learning and artificial intelligence techniques. A total of 559 patients underwent breast ultrasound, mammography, and ultrasound-guided breast biopsy. Based on the histopathological results, the patients were divided into three categories: benign, ductal carcinomas, and non-ductal carcinomas. The mammograms in the cranio-caudal view underwent pre-processing and segmentation. Given the large variability of the areola, an algorithm was used to remove it and the adjacent skin. Therefore, patients with breast lesions close to the skin were removed. The remaining breast image was resized on the Y axis to a square image and then resized to 512 × 512 pixels. A variable square of 322,622 pixels was searched inside every image to identify the lesion. Each image was rotated with no information loss. For data augmentation, each image was rotated 360 times and a crop of 227 × 227 pixels was saved, resulting in a total of 201,240 images. The reason why our images were cropped at this size is because the deep learning algorithm transfer learning used from AlexNet network has an input image size of 227 × 227. The mean accuracy was 95.8344% ± 6.3720% and mean AUC 0.9910% ± 0.0366%, computed on 100 runs of the algorithm. Based on the results, the proposed solution can be used as a non-invasive and highly accurate computer-aided system based on deep learning that can classify breast lesions based on changes identified on mammograms in the cranio-caudal view.

The Effect of Silver Nanoparticles on Antioxidant/Pro-Oxidant Balance in a Murine Model.

This study aimed to evaluate the subacute effect of two types of Ag-NPs(EG-AgNPs and PVP-EG-AgNPs) on antioxidant/pro-oxidant balance in rats. Seventy Wistar rats (35 males and 35 females) were divided in 7 groups and intraperitoneally exposed for 28 days to 0, 1, 2 and 4 mg/kg bw/day EG-Ag-NPs and 1, 2 and 4 mg/kg bw/day PVP- EG-Ag-NPs. After 28 days, the blood was collected, and the total antioxidant capacity (TAC), thiobarbituric reactive species (TBARS),protein carbonyl (PROTC) levels, reduced glutathione (GSH) levels and catalase (CAT) activity were determined. EG-Ag-NPs determined protective antioxidant effects in a dose-dependent manner. The exposure to the 4 mg/kg bw/day EG-Ag-NPs determines both in males and females a significant increase in TAC and CAT and a significant decrease in TBARS and PROTC only in females. The PVP-EG-AgNPs showed a different trend compared to EG-AgNPs. At 4 mg/kg bw/day the PVP-EG-AgNPs induce increased PROTC levels and decreased GSH (males and females) and TAC levels (males). The different mechanisms of EG-AgNPs and PVP-EG-AgNPs on antioxidant-/pro-oxidant balance can be explained by the influence of coating agent used for the preparation of the nanoparticles in the formation and composition of protein corona that influence their pathophysiology in the organism.

EUS Needle Identification Comparison and Evaluation study (with videos).

BACKGROUND AND AIMS: EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS: Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS: There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS: All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.

Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos).

BACKGROUND: The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation. OBJECTIVE: To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP). SETTING: Prospective, multicenter, observational trial-endoscopy units from Romania, Denmark, Germany, and Spain. PATIENTS: A total of 167 consecutive patients with PC or CP. INTERVENTIONS: Contrast-enhanced harmonic EUS (CEH-EUS) and EUS-guided FNA (EUS-FNA), TIC analysis, and ANN processing. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN. RESULTS: After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%. LIMITATIONS: Only PC and CP lesions were included. CONCLUSION: Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used in an automated computer-aided diagnostic system with good diagnostic results. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01315548.).

Assessment of Dietary and Lifestyle Quality among the Romanian Population in the Post-Pandemic Period.

BACKGROUND: The pandemic caused by the SARS-CoV-2 virus demonstrated the importance of prevention through a healthy diet and lifestyle, the most vulnerable people being those with severe chronic conditions, those who are overweight, and those with an unbalanced immune system. This study aims to examine the nutritional status and lifestyle behaviors of the Romanian population. METHODS: The evaluation of the eating habits and lifestyle of the Romanian population in the post-pandemic period was carried out based on a cross-sectional observational study with the help of a questionnaire. RESULTS: A total of 4704 valid answers were registered (3136 female and 1568 male respondents). Among the respondents, most of them belong to the young population, 2892 between the ages of 18 and 40, i.e., 61.5%. Most male respondents are overweight (1400) and obese (780). Most respondents indicated a tendency to consume 1-2 meals per day irregularly (p = 0.617). Only 974 respondents adopted a healthy diet, and 578 a healthy lifestyle. CONCLUSIONS: The present study reports low adherence to a healthy diet (20.7%) and healthy lifestyle (12.28%), especially among the young population (<30 years). In the current context, it reports a reduced tendency to consume vegetables and fruits among the population, below the daily average recommended by the nutrition guidelines, a tendency towards sedentary behavior, and even deficient hydration of some of the respondents; these negative aspects can create a long-term series of nutritional and psycho-emotional imbalances. Our results evidence that complex surveys among the population are regularly required to investigate nutritional or lifestyle deficiencies; moreover, it could be helpful in further educational measures in nutrition, food, and environmental safety.

Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach.

This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.

Integrative Approach to Risk Factors in Simple Chronic Obstructive Airway Diseases of the Lung or Associated with Metabolic Syndrome-Analysis and Prediction.

We conducted an epidemiological non-interventional cross-sectional and case-control study from 1 January 2023 until 26 May 2023 in Oltenia region, southwestern Romania. Throughout the research, 160 consecutive patients were included from two different clinical departments (1-Pneumology; 2-Diabetes and Nutritional Diseases). Subjects were voluntary adult individuals of any gender who expressed their written consent. The clinical data of the patients were correlated with the exposure to behavioral risk factors (diet, lifestyle, exposure to pollutants) to identify some negative implications that could be corrected to improve the quality of life of patients with simple chronic obstructive airway diseases of the lung or associated with metabolic syndrome (MS). In the first group of patients with respiratory diseases, there was a higher degree of exposure to toxic substances (43.75%) compared to the second group of patients with diabetes (18.75%); it is also noticeable that in the first group, there were noticeably fewer individuals who have never smoked (25%) compared to the second group (50%). Respiratory function impairment was observed to be more severe in overweight individuals. In the group of patients with known lung diseases, a positive correlation was noted between the presence of MS and respiratory dysfunctions of greater severity. Additionally, potential exacerbating factors affecting lung function, such as direct exposure to toxins and smoking, were considered. Potential secondary factors exacerbating respiratory dysfunction were considered by correlating biochemical parameters with dietary habits. These included reduced consumption of vegetables, inadequate hydration, and increased intake of sweets and products high in saturated or trans fats (commonly found in junk food), primarily due to their potential contribution to excess weight. Compared to patients without MS, the severity of the pulmonary function impairment correlated with the number of criteria met for MS and, independently, with an increase in weight.

Comparison between Substance P and Calcitonin Gene-Related Peptide and Their Receptors in Colorectal Adenocarcinoma.

Background: Colorectal cancer is a major health problem that still causes many deaths worldwide. Neuropeptides, such as substance P and calcitonin gene-related peptide, play the neurotransmitter and neurohormone roles that increase tumor invasiveness and metastasis potential. This study aimed to see whether these neuropeptides and their receptors-neurokinin 1 receptor and calcitonin receptor-like receptor-correlate with the diagnosis stage, tumor differentiation grade, and different patient characteristics in colorectal cancer and also to compare them. Methods: We performed serum analyses of substance P and CGRP levels in patients with colorectal cancer and also the immunohistochemical analysis of their receptors in colorectal tumors and then correlated them with the disease stage and with different tumor characteristics. Results: We demonstrated that both substance P and calcitonin gene-related peptide had increased levels in colorectal cancer and that their levels correlated with the stage of the disease and with the tumor differentiation grade. We also demonstrated the correlation of NK-1R and CRLR higher immunohistochemical scores with advanced and poorly differentiated tumors. Conclusions: This study demonstrates that the neuropeptides SP and CGRP and their receptors NK-1R and CRLR could play a role in the pathogenesis of colorectal cancer, and they could be used as diagnostic and prognostic markers and could represent potential therapeutic targets.

Assessment of Behavioral Risk Factors in Chronic Obstructive Airway Diseases of the Lung Associated with Metabolic Syndrome.

BACKGROUND: Diet and lifestyle play important roles in preventing and improving chronic diseases, and evaluating behavioral risk factors in these pathologies allows for efficient management. METHODS: A clinical study by screening biochemical parameters and pulmonary function was carried out to evaluate behavioral risk factors in obstructive pulmonary disease associated with metabolic syndrome. RESULTS: Of the total of 70 patients included in the clinical study, 46 were men and 24 were women (χ2 = 3.9, p = 0.168). Forty-eight patients presented at least three met risk criteria associated with the metabolic syndrome (19 women and 29 men). Regarding the assessment of lung function, only 7 of the patients presented normal spirometry values (χ2 = 75.28, p < 0.001), and the other 63 patients presented with ventilatory dysfunction; most (over 80%) declared that they were smokers or had smoked in the past (χ2 = 5.185, p = 0.075). In terms of body weight, 45 of the patients are overweight or obese, most of them declaring that they do not consume enough vegetable products, they consume large amounts of foods of animal origin (meat, milk, eggs) but also super processed foods (food products type of junk food), do not hydrate properly, and are predominantly sedentary people (54 of the patients do no physical activity at all; χ2 = 2.12, p = 0.713). CONCLUSION: From the statistical processing of the data, it is noted that insufficient hydration, low consumption of vegetables, increased consumption of hyper-caloric food products rich in additives, sedentary lifestyle, and smoking are the main disruptive behavioral factors that worsen the health status in lung disease associated with the metabolic syndrome. An important conclusion emerging from the study is that the imbalances that aggravate obstructive lung diseases are generated by unhealthy food and an unbalanced lifestyle.

Multicenter randomized controlled trial comparing the performance of 22 gauge versus 25 gauge EUS-FNA needles in solid masses.

BACKGROUND AND AIMS: Few randomized studies have assessed the clinical performance of 25-gauge (25G) needles compared with 22-gauge (22G) needles during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy of intra-abdominal lesions. We aimed to compare the diagnostic yield, as well as performance characteristics of 22G versus 25G EUS biopsy needles by determining their diagnostic capabilities, the number of needle passes as well as cellularity of aspirated tissue specimen. METHODS: The study is a prospective, randomized, multicenter study. Patients were referred between January 2009 and January 2010 for diagnostic EUS including EUS-guided FNA of different lesions adjacent to the upper GI tract. All patients were randomized to EUS-FNA performed with either a 22G or 25G aspiration needle. RESULTS: EUS-FNA was performed in 135 patients (62 patients with a 22G needle). Sensitivity and specificity of the 22G needle was 94.1% and 95.8%, respectively, and for the 25G needle 94.1% and 100%, respectively. Investigators reported better visualization and performance for the 22G needle compared to the 25G (p < 0.0001). The number of tissue slides obtained was higher for the 22G needle during the second and third needle passes (p < 0.05). We did not observe significant differences between the number and preservation status of obtained cells (p > 0.05). CONCLUSIONS: A significant difference was found between the two types of needles in terms of reduced visualization of the 25G needle and suboptimal performance rating. However, this did not impact on overall results since both needles were equally successful in terms of a high diagnostic yield and overall accuracy.

Quantitative low mechanical index contrast-enhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer.

BACKGROUND: Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, as well as improved staging and guidance of therapeutic procedures. METHODS: The aim of our study was to prospectively compare the vascularisation patterns in chronic pseudotumoral pancreatitis and pancreatic cancer using quantitative low mechanical index (MI) contrast-enhanced EUS. We included 51 patients with chronic pseudotumoral pancreatitis (n = 19) and pancreatic cancer (n = 32). Perfusion imaging started with a bolus injection of Sonovue (2.4 ml), followed by analysis in the early arterial (wash-in) and late venous (wash-out) phase. Perfusion analysis was performed by post-processing of the raw data (time intensity curve [TIC] analysis). TIC analysis was performed inside the tumor and the pancreatic parenchyma, with depiction of the dynamic vascular pattern generated by specific software. Statistical analysis was performed on raw data extracted from the TIC analysis. Final diagnosis was based on a combination of EUS-FNA, surgery and follow-up of minimum 6 months in negative cases. RESULTS: The sensitivity and specificity of low MI contrast enhanced EUS using TIC were sensitivity and specificity of low MI contrast enhanced EUS using TIC analysis were 93.75% (95% CI = 77.77-98.91%) and 89.47% (95% CI = 65.46-98.15%), respectively. Pseudotumoral chronic pancreatitis showed in the majority of cases a hypervascular appearance in the early arterial phase of contrast-enhancement, with a dynamic enhancement pattern similar with the rest of the parenchyma. Statistical analysis of the resulting series of individual intensities revealed no statistically relevant differences (p = .78). Pancreatic adenocarcinoma was usually a hypovascular lesion, showing low contrast-enhancement during the early arterial and also during the late venous phase of contrast-enhancement, also lower than the normal surrounding parenchyma. We found statistically significant differences in values during TIC analysis (p < .001). CONCLUSIONS: Low MI contrast enhanced EUS technique is expected to improve the differential diagnosis of focal pancreatic lesions. However, further multicentric randomized studies will confirm the exact role of the technique and its place in imaging assessment of focal pancreatic lesions.

Probe - Based Confocal Endomicroscopy and Endoscopy in NBI Module - The Role in Clinical Decision - Case Reports.

Cancer remains a significant global cause of mortality, irrespective of a country's level of development. Among all cancer types, gastrointestinal cancers claim the highest number of lives annually. This disease predominantly affects individuals in their 6th to 8th decades of life. Unfortunately, diagnoses often occur during advanced stages of the illness, rendering chemotherapy less effective and offering a reserved prognosis. Conventional endoscopy, however, struggles to differentiate lesions based on their histological composition. Consequently, the management of patients largely depends on histopathological examinations, which can be time-consuming. Biopsy results are sometimes delayed, with precious weeks passing, particularly critical for patients with malignant lesions. Moreover, biopsies may yield inconclusive results if not precisely targeted, leading to potential mismanagement, unnecessary resections and burdensome pathology services. This series of cases underscores, as previous studies have, the value of modern endoscopic techniques in determining the appropriate therapeutic approach for each patient, an approach that ensures the highest quality of life.

Genomic Profiling - A Need for Clinical Decision? -Case Reports.

Cancer is still an important health issue worldwide due to increased incidence and mortality. Personalized medicine is the future of cancer treatment. Development in technology improved technical skills in DNA/RNA sequencing. NGS technology in solid-tumor samples can describe DNA or RNA analysis by including the entire genome to detect clinical relevant mutations. Genetic results may be considered having a dynamic impact because of heterogenous molecular alterations depending of time and treatment influence. We conducted a retrospective study of all NGS tests made in the last five years for the patients from 'Sf. Nectarie' Oncology Center, Craiova, Romania. We selected three relevant clinical cases where NGS analysis was performed and the results changed the perspective of the clinical decision. Our aim is to evaluate the importance of NGS results in clinical approach. Although medicine known an important development during the last decades, only a few patients can benefit of advanced personalized treatments. It is still hard to identify the alterations or gene mutations because of genetic tests are not easily available and only a small proportion of patients carries genetic alterations.

Diagnostic Performance of an Artificial Intelligence Model Based on Contrast-Enhanced Ultrasound in Patients with Liver Lesions: A Comparative Study with Clinicians.

Contrast-enhanced ultrasound (CEUS) is widely used in the characterization of liver tumors; however, the evaluation of perfusion patterns using CEUS has a subjective character. This study aims to evaluate the accuracy of an automated method based on CEUS for classifying liver lesions and to compare its performance with that of two experienced clinicians. The system used for automatic classification is based on artificial intelligence (AI) algorithms. For an interpretation close to the clinical setting, both clinicians knew which patients were at high risk for hepatocellular carcinoma (HCC), but only one was aware of all the clinical data. In total, 49 patients with 59 liver tumors were included. For the benign and malignant classification, the AI model outperformed both clinicians in terms of specificity (100% vs. 93.33%); still, the sensitivity was lower (74% vs. 93.18% vs. 90.91%). In the second stage of multiclass diagnosis, the automatic model achieved a diagnostic accuracy of 69.93% for HCC and 89.15% for liver metastases. Readers demonstrated greater diagnostic accuracy for HCC (83.05% and 79.66%) and liver metastases (94.92% and 96.61%) compared to the AI system; however, both were experienced sonographers. The AI model could potentially assist and guide less-experienced clinicians to discriminate malignant from benign liver tumors with high accuracy and specificity.

An Automated Method for Classifying Liver Lesions in Contrast-Enhanced Ultrasound Imaging Based on Deep Learning Algorithms.

BACKGROUND: Contrast-enhanced ultrasound (CEUS) is an important imaging modality in the diagnosis of liver tumors. By using contrast agent, a more detailed image is obtained. Time-intensity curves (TIC) can be extracted using a specialized software, and then the signal can be analyzed for further investigations. METHODS: The purpose of the study was to build an automated method for extracting TICs and classifying liver lesions in CEUS liver investigations. The cohort contained 50 anonymized video investigations from 49 patients. Besides the CEUS investigations, clinical data from the patients were provided. A method comprising three modules was proposed. The first module, a lesion segmentation deep learning (DL) model, handled the prediction of masks frame-by-frame (region of interest). The second module performed dilation on the mask, and after applying colormap to the image, it extracted the TIC and the parameters from the TIC (area under the curve, time to peak, mean transit time, and maximum intensity). The third module, a feed-forward neural network, predicted the final diagnosis. It was trained on the TIC parameters extracted by the second model, together with other data: gender, age, hepatitis history, and cirrhosis history. RESULTS: For the feed-forward classifier, five classes were chosen: hepatocarcinoma, metastasis, other malignant lesions, hemangioma, and other benign lesions. Being a multiclass classifier, appropriate performance metrics were observed: categorical accuracy, F1 micro, F1 macro, and Matthews correlation coefficient. The results showed that due to class imbalance, in some cases, the classifier was not able to predict with high accuracy a specific lesion from the minority classes. However, on the majority classes, the classifier can predict the lesion type with high accuracy. CONCLUSIONS: The main goal of the study was to develop an automated method of classifying liver lesions in CEUS video investigations. Being modular, the system can be a useful tool for gastroenterologists or medical students: either as a second opinion system or a tool to automatically extract TICs.

The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic.

We aimed to evaluate the outcomes and survival of patients with acute pancreatitis who shared the same clinical form, age, and sex before the pandemic, during the pandemic, and among those with confirmed COVID-19 infection upon hospital admission. This consideration used the sparse data in the existing literature on the influence of the pandemic and COVID-19 infection on patients with acute pancreatitis. To accomplish this, we conducted a multicentric, retrospective case-control study using propensity score matching with a 2:1 match of 28 patients with SARS-CoV-2 infection and acute pancreatitis, with 56 patients with acute pancreatitis pre-pandemic, and 56 patients with acute pancreatitis during the pandemic. The study outcome demonstrated a six-fold relative risk of death in patients with acute pancreatitis and SARS-CoV-2 infection compared to those with acute pancreatitis before the pandemic. Furthermore, restrictive measures implemented during the pandemic period led to a partial delay in the care of patients with acute pancreatitis, which likely resulted in an impairment of their immune state. This, in certain circumstances, resulted in a restriction of surgical treatment indications, leading to a three-fold relative risk of death in patients with acute pancreatitis during the pandemic compared to those with acute pancreatitis before the pandemic.

Preoperative Immunocyte-Derived Ratios Predict Postoperative Recovery of Gastrointestinal Motility after Colorectal Cancer Surgery.

The aim of this study was to assess the role of immunocyte-derived ratios (IDRs), such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), as markers for the postoperative recovery of gastrointestinal function following colorectal cancer surgery. A retrospective analysis was conducted on a consecutive cohort of 260 patients who underwent radical colorectal cancer surgery within the timeframe spanning from January 2016 to December 2022. Data concerning the postoperative recovery of gastrointestinal function included the I-FEED score, time to pass flatus, toleration for liquids in the first 48 h, and the need for nasogastric tube reinsertion in the immediate postoperative period. A special emphasis was allocated towards the examination of IDRs and their interrelation with the postoperative gastrointestinal functional parameters. The I-FEED score exhibited a positive correlation with the NLR, SII, and PLR. The univariate analysis indicated that all IDRs, multiorgan resection, hemoglobin and protein levels, regional nodal extent of the tumor (N), and obesity significantly affected nasogastric tube reinsertion. The multivariate analysis showed that the SII and N1 stages were risk factors for nasogastric tube reinsertion after colorectal cancer surgery. The SII and multiorgan resection were the only classifiers that remained significant in the multivariable analysis for the toleration for liquids. In summation, certain preoperative IDRs, such as the SII, PLR, and NLR, may hold potential as predictive determinants for postoperative gastrointestinal functional recovery following colorectal cancer surgery.

Lipid serum profile in patients with viral liver cirrhosis.

OBJECTIVE: Our main aim was to investigate the serum lipid levels in a series of patients with liver cirrhosis of viral origin. SUBJECTS AND METHODS: The study comprised 90 patients, 60 with viral liver cirrhosis, equally divided between hepatitis virus C (HCV) and B (HBV) etiologies, and 30 control patients with no known liver pathology. Patients were investigated during a 5-year period in the 1st Medical Clinic of the Emergency County Hospital of Craiova, Romania. The following series of serum lipid parameters were recorded: lipemia, total cholesterol and cholesteryl ester, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol and triglyceride (TG) values. Statistical analysis of these parameters was performed using the ANOVA test followed by Tukey multiple comparison tests to compare replicate means; p < 0.05 was considered statistically significant. RESULTS: We observed significantly lower values for serum lipids (543.5 and 549.37 mg/dl in the HBV and HCV cirrhosis subgroups, compared with 649.9 mg/dl in controls), total cholesterol (143.6 and 147.9 vs. 198.0 mg/dl, respectively), cholesteryl esters (83.6 and 80, compared to 147.9 mg/dl, respectively), LDL cholesterol (91.6 and 88.5 vs. 132.4 mg/dl) in both cirrhosis groups when compared with controls (p < 0.001), as well as HDL cholesterol (32.1 and 36.9 vs. 47.3 mg/dl, p < 0.05). However, TG and VLDL cholesterol values of controls and cirrhosis groups were similar (p > 0.05). We did not register any differences between the two cirrhosis groups (p > 0.05). CONCLUSION: Our data showed that both HCV and HBV cirrhosis severely impaired liver lipid metabolism. Late stages of the disease resulted in a pseudonormalization of VLDL cholesterol and TG values.

Perceived Stress in Hepatitis C Virus Infected Patients under the DAA-Based Therapy.

The Hepatitis C Virus (HCV) infection often associates medical and mental health conditions which lead to increased levels of distress. Our study aimed at assessing the level of perceived stress on a sample of 90 HCV infected patients treated with Direct-Acting Antiviral (DAA) agents for 12 weeks, and its possible correlations with clinical and evolutionary elements. The evaluation was conducted in three phases: before administration of the DAAs (BSL), at the End of the Treatment (EOT), and 24 weeks after the BSL (Sustained Viral Response­SVR). The perceived stress was measured using the Perceived Stress Scale (PSS). The efficiency of the DAA treatment reduced the levels of stress (98.99% moderate and high stress at BSL to 70.00% at SVR). It was observed, for the entire study period (BSL to SVR), that the decrease in the perceived stress severity was significantly associated with demographic items such as gender (p < 0.01), urban environment (p < 0.001), the age of the subjects (p < 0.05), and clinical data such as F4 degree of fibrosis (p = 0.001) and overweight or obesity class II (p < 0.01). The perceived stress is directly associated with the severity of the HCV infection, and it could be significantly lowered by an efficient therapeutic approach, as DAAs are nowadays.

Resource Management through Artificial Intelligence in Screening Programs-Key for the Successful Elimination of Hepatitis C.

BACKGROUND: The elimination of the Hepatitis C virus (HCV) will only be possible if rapid and efficient actions are taken. Artificial neural networks (ANNs) are computing systems based on the topology of the biological brain, containing connected artificial neurons that can be tasked with solving medical problems. AIM: We expanded the previously presented HCV micro-elimination project started in September 2020 that aimed to identify HCV infection through coordinated screening in asymptomatic populations and developed two ANN models able to identify at-risk subjects selected through a targeted questionnaire. MATERIAL AND METHOD: Our study included 14,042 screened participants from a southwestern region of Oltenia, Romania. Each participant completed a 12-item questionnaire along with anti-HCV antibody rapid testing. Hepatitis-C-positive subjects were linked to care and ultimately could receive antiviral treatment if they had detectable viremia. We built two ANNs, trained and tested on the dataset derived from the questionnaires and then used to identify patients in a similar, already existing dataset. RESULTS: We found 114 HCV-positive patients (81 females), resulting in an overall prevalence of 0.81%. We identified sharing personal hygiene items, receiving blood transfusions, having dental work or surgery and re-using hypodermic needles as significant risk factors. When used on an existing dataset of 15,140 persons (119 HCV cases), the first ANN models correctly identified 97 (81.51%) HCV-positive subjects through 13,401 tests, while the second ANN model identified 81 (68.06%) patients through only 5192 tests. CONCLUSIONS: The use of ANNs in selecting screening candidates may improve resource allocation and prioritize cases more prone to severe disease.